Abstract 17366: Is Ablation of Atrial Fibrillation in Patients With Chronic Left Atrial Appendage Thrombus Safe?
Introduction: Catheter ablation of atrial fibrillation is an independent risk factor for stroke. Whether the presence of chronic left atrial appendage thrombus prior to the procedure in pts with therapeutic INR is associated with a higher risk of stroke or represents a contraindication is unknown.
Methods: 21 patients with drug refractory symptomatic atrial fibrillation were found to have a chronic left atrial appendage thrombus by CT and TEE. After 8 weeks of therapeutic Coumadin therapy, TEE showed stable chronic thrombus in all 21 patients. Pulmonary vein isolation was performed in all patients under a mean “therapeutic” INR of 2.53±0.28.
Results: 7 patients had hypertrophic cardiomyopathy, 8 pts had ischemic cardiomyopathy and 6 patients had non ischemic cardiomyopathy. The mean age was 63 ± 6 and the mean EF was 25 ± 6 %. All patients had an ICD. No patients had periprocedural stroke. Sixteen patients were free from recurrences after 10 ± 3 month follow up. Two pts underwent a second procedure and one patient had 3 procedures.In 12 patients (57%) ablation was performed at the mouth of the left atrial appendage.
Conclusions: Catheter ablation of atrial fibrillation in patients with chronic left atrial appendage thrombus and with a therapeutic INR at the time of the procedure seems to be safe and not associated with increased risk of peri-procedural stroke.
- © 2010 by American Heart Association, Inc.